<div style="width: 600px;">
<form id="policy_frm" name="policy_frm" action="?p={page}&amp;a={action}" method="post">

<table id="policy" border="1" width="100%">
<tr><th width="15%">{ins_comp}</th><td><select id="ins_comp" name="ins_comp"{selects_disabled}><option value=""{empty_selected}></option>{ins_comps}</select></td></tr>
<tr><th>{nr}</th><td><input size="75" id="pol_nr" name="pol_nr" value="{nr_value}" /></td></tr>
<tr><th>{add_nr}</th><td><input size="75" id="pol_add_nr" name="pol_add_nr" value="{add_nr_value}" /></td></tr>
<tr><td>{pol_attr}<input name="pol_attr" type="checkbox"{pol_attr_checked} /></td><td>{canceled}<input name="pol_canc" type="checkbox"{pol_canc_checked} /></td></tr>
</table>

<table id="policy2" border="1" width="100%">
<tr><th width="15%">{ins_type}</th><td><select id="ins_type" name="ins_type" onchange="ins_type_update({ins_type_update_check_db})"{selects_disabled}><option value=""{empty_selected}></option>{ins_types}</select></td></tr>
<tr><th>{status}</th><td><select id="status" name="status" onchange="toogle_status();"{selects_disabled}><option value=""{empty_selected}></option>{statuses}</select></td></tr>
<tr><th>{prev_pol_nr}</th><td><input id="prev_pol" name="prev_pol" type="text"{prev_pol_disabled} value="{prev_pol_value}" /></td></tr>
<tr><th>{taker}</th><td><select style="max-width: 530px" id="taker" name="taker"{selects_disabled}><option value=""{empty_selected}></option>{takers}</select></td></tr>
<tr><th>{owner}</th><td><select style="max-width: 530px" name="owner"{selects_disabled}><option value=""{empty_selected}></option>{owners}</select></td></tr>
</table>

<table id="policy3" border="1" width="100%">
<tr><th width="15%">{ins_objects}</th><td>
<table>
<tr>
<td><select id="obj_type1" name="obj_type1" onchange="getObjList(this,1);"{selects_disabled}><option value=""{empty_selected}></option>{obj_types1}</select></td>
<td><select id="obj_type2" name="obj_type2" onchange="getObjList(this,2);"{selects_disabled}><option value=""{empty_selected}></option>{obj_types2}</select></td>
</tr>
<tr><td><select style="max-width: 245px" id="object1" name="object1" onchange="changeObjLink(this,1);"{selects_disabled}><option value=""{empty_selected}></option>{object1}</select><a onclick="newWindow(this,\'View Object\',400,400); return false;" id="object_link1" href="javascript: alert('{select_object}');"><img src="img/view.png" alt="{view_object}" width="16" height="16"/></a></td><td><select style="max-width: 245px" id="object2" name="object2" onchange="changeObjLink(this,2);"{selects_disabled}><option value=""{empty_selected}></option>{object2}</select><a onclick="newWindow(this,\'View Object\',400,400); return false;" id="object_link2" href="javascript: alert('{select_object}');"><img src="img/view.png" alt="{view_object}"  width="16" height="16" /></a></td></tr>
</table>
</td></tr>
</table>

<table id="policy_dynamic" border="1" width="100%">
<tr><th width="15%">{cta_premium}</th><td><input type="text" id="cta_premium" name="cta_premium" value="{cta_premium_value}" /></td><td><b>{persons_count}:</b> <input type="text" id="persons_count" name="persons_count" disabled="disabled" /></td></tr>
<tr><th width="15%">{ng_premium}</th><td><input type="text" id="ng_premium" name="ng_premium" value="{ng_premium_value}" /></td><td></td></tr>
<tr style="display: none"><th width="15%">{TL_code}</th><td><select id="TL_codes" name="TL_codes"{selects_disabled}><option value=""{empty_selected}></option>{tl_codes}</select></td><td><b>{riska_class}:</b> <input type="text" id="riska_class" name="riska_class" value="{riska_class_value}" /></td></tr>
<tr style="display: none"><th>{octa_premium}</th><td><select name="octa_premium" id="octa_premium"{selects_disabled}><option value=""{empty_selected}></option>{octa_examples}</select></td><td><b>{octa_discounts}:</b> <select name="octa_discounts" id="octa_discounts"{selects_disabled}><option value=""{empty_selected}></option>{octa_discountss}</select></td></tr>
<tr><th>{validity_territory}</th><td><select name="val_ter"{selects_disabled}><option value=""></option>{val_territories}</select></td><td></td></tr>
</table>

<table border="1" width="100%">
<tr><th width="15%">{issue_date}</th><td><input type="text" name="issue_date" class="tcal" value="{issue_date_value}" /></td></tr>
<tr><th>{validity_period}</th><td>{from}: <input type="text" id="date_from" name="date_from" class="tcal" value="{date_from_value}" /><input type="text" size="5" maxlength="5" name="date_from_time" value="{date_from_time_value}" /> {to}: <input type="text" id="date_to" name="date_to" class="tcal" value="{date_to_value}" /></td></tr>
<tr><th>{payment_count}</th><td><input type="text" id="payment_count" name="payment_count" value="{payment_count_value}" /> {payment_type}: <select name="payment_type"{selects_disabled}><option value="0"{payment_none_selected}></option><option value="1"{payment_cash_selected}>{cash}</option><option value="2"{payment_transfer_selected}>{transfer}</option></select></td></tr>
<tr><th>{currency}</th><td><select id="currency" name="currency"{selects_disabled}><option value=""{empty_selected}></option>{currencies}</select></td></tr>
<tr><th>{ins_sum}</th><td><input type="text" name="ins_sum" value="{ins_sum_value}" /></td></tr>
<tr><th>{ins_prem}</th><td><input type="text" id="ins_prem" name="ins_prem" value="{ins_prem_value}" /></td></tr>
<tr><th>{policy_subscriber}</th><td><select style="max-width: 500px" name="policy_subscriber"{selects_disabled}><option value=""></option>{subscribers}</select></td></tr>
<tr><th>{commision_perc} %</th><td><input id="commision_perc" name="commision_perc" type="text" size="5" maxlength="5" value="{commision_perc_value}" /></td></tr>
<tr><th>{broker_perc} %</th><td><input id="broker_perc" name="broker_perc" onchange="brokerPercChange();" type="text" size="5" maxlength="5" value="{broker_perc_value}" /><select id="broker" name="broker" style="display: none"{selects_disabled}><option value=""{empty_selected}></option>{brokers}</select></td></tr>
<tr><th>{discount_perc} %</th><td><input name="discount_perc" type="text" size="5" maxlength="5" value="{discount_perc_value}" /></td></tr>
</table>

<table border="1" width="100%"><tr><th>{comment}</th><td><textarea{comment_readonly} id="comment" rows="5" cols="50" name="comment" style="width: 99%; color:black;">{comment_value}</textarea></td></tr>
<tr><th width="15%">{employee}</th><td><select id="employee" name="employee"{selects_disabled}><option value=""></option>{employees}</select></td></tr>
</table>
<center>
{payment_button}
<input type="button" class="yt_button" value="{button_lang}" onclick="{button_click}" /></center>
</form>
<script type="text/javascript" language="javascript">
{init_js}
</script>
</div>